Your Guide to Selecting the Right Laser Safety Standard
As more and more workplaces in the United States begin to implement laser technology, the need to stay on the leading edge of laser safety updates becomes more important. Laser Safety Officers (LSOs) know that the best way to stay informed about laser safety standards and practices is to become familiar with the American National Standards Institute’s (ANSI) Z136 series of laser safety standards.
Job shops, researchers and medical professionals want to prevent accidents. By following the ANSI standards, you are promoting a safe work environment while avoiding costly accidents and improving your overall safety footprint.
Having the laser safety standard most applicable to your profession is essential to maintaining a successful laser safety program. They are the only laser safety guidelines that are nationally accepted by a variety of organizations, including the Occupational Safety and Health Administration (OSHA) and The Joint Commission (TJC). And since the Laser Institute of America (LIA) serves as the publisher of the series, you can be confident that you are purchasing the most current laser safety information available.
The Z136 standards are revised after an extensive review process is completed to ensure that all information is correct and up-to-date. This process is led by one main committee, and further composed of an oversight committee, an editorial working group, five technical committees and 10 “standards” committees that are each responsible for a specific standard. Once a subcommittee has completed a standard, the other committees review the document — a process that can take several years.
Before publishing, the American National Standards Institute approves the document. However, ANSI does not approve the content. It approves the process by which the document was revised to “verify that the principles of openness and due process have been followed and that a consensus of all interested stakeholder groups has been reached.” Once ANSI has approved the document, the secretariat makes any necessary formatting and grammatical edits before being sent to print.
The most recent update to the laser safety standards is the ANSI Z136.6 Safe Use of Lasers Outdoors. The 2015 revision expands upon the previous version and hopes to meet the evolving needs of outdoor laser operators. Designed for use by laser-light show operators, scientific and astronomical research, the Department of Energy, and the Department of Defense, the revised ANSI Z136.6 provides guidance for the safe use of lasers and laser systems (180 nm to 1 mm) that could possibly be hazardous in outdoor environments where open-beam paths are necessary.
There are a number of additional Z136 laser safety standards available that cater to a variety of industries and professionals, not just those that use laser technology outdoors, including:
ANSI Z136.1 Safe Use of Lasers
ANSI Z136.2 Safe Use of Optical Fiber Communication Systems Utilizing Laser Diode and LED Sources
ANSI Z136.3 Safe Use of Lasers in Health Care
ANSI Z136.4 Recommended Practice for Laser Safety Measurements for Hazard Evaluation
ANSI Z136.5 Safe Use of Lasers in Educational Institutions
ANSI Z136.7 Testing and Labeling of Laser Protective Equipment
ANSI Z136.8 Safe Use of Lasers in Research, Development, or Testing
ANSI Z136.9 Safe Use of Lasers in Manufacturing Environments
As the parent document of the ANSI Z136 standards, Z136.1 is the number one seller and the standard that most laser safety officers purchase, according to Barbara Sams, the Executive Director of the Board of Laser Safety. This tool is essential for any LSO to have on hand.
In addition to this tool, having the laser safety standard that’s most applicable to your industry is another great way to keep your laser safety program current, as it can serve as both a reference tool and a guide for your laser safety initiatives. Because laser safety measures are different for each industry, control measures for one industry can be very different from another. In health care, you would use Z136.3; in manufacturing, you would use Z136.9; and so on. Control measures for one area of practice do not necessarily apply to the other.
If you are just now beginning your journey as a Laser Safety Officer, the Z136 standards are a great tool to have while you complete the necessary training and develop your laser safety program. Thesestandards provide protocols and procedures you can use to create a laser safety program in a facility that may not have had one before. By following the guidelines outlined in the standards, you are protecting your employees and satisfying OSHA requirements that state all employers must provide a safe workplace that meets a national consensus standard, in this case laser safety.
The photonics industry is ever-changing, and LIA is dedicated to helping LIA members and non-members alike get the resources they need to ensure their laser safety programs are safe and up-to-date. If you have purchased one of the Z136 standards in the past, LIA will send you an email notification when the standard is revised — allowing you to stay on the forefront of new laser safety information.
You may purchase any of the Z136 laser safety standards in print or digital format on LIA’s website. If you have any questions about the ANSI standards or LIA laser safety training options, you may contact us online.
Laser Institute of America (LIA) will hold its biennial International Laser Safety Conference (ILSC®) from Mar. 20-23, 2017. At the Sheraton® Atlanta Airport, LIA will gather laser safety experts from around the globe to offer a thorough and comprehensive four-day conference for a variety of laser industry members. From laser safety officers and nurses, to safety product manufacturers and laser physicists, attendees will not only gain invaluable information from sessions, but will also have the opportunity to network with others and take part in this community of laser safety experts.
In 2017, ILSC – the premiere conference in the field of laser safety – will be led by Conference General Chair John O’Hagan of the Health Protection Agency. The 2017 program will feature knowledgeable speakers and presenters in the plenary session, the poster presentation gallery, the Laser Safety Scientific Sessions (LSSS), the Medical Practical Applications Seminar (MPAS) and the Technical Practical Applications Seminar (TPAS). The MPAS will be co-chaired by Kay Ball, Vangie Dennis, Patti Owens and Leslie Pollard.
Co-chaired by Eddie Ciprazo and Jamie King, the focus of TPAS in 2017 will be a return to the basics. “For the Laser Safety Officer (LSO) who is just starting out, who serves as a collateral duty, or even as a seasoned LSO with years of experience, there is something for everyone,” explains King. “From basic optics to cutting edge technologies, and everything in between, it’s here.”
Karl Schulmeister, Chair for LSSS, assures that ILSC will continue to cover the subject matter that attendees have found most helpful over the years. Among the planned topics are laser product safety, medical laser safety, and bioeffects. The latter will expand upon the interactions between lasers and tissues, discussing injury thresholds for the varying tissues of the eye and skin. Other sessions will focus on eyewear, outdoor lasers, high power lasers and materials processing. Broadband incoherent radiation will also be featured, as these lighting and other non-laser optical radiation sources have become interwoven with laser safety in recent years.
The ILSC 2017 Call for Papers is open for submissions. Authors are invited to submit their abstracts for oral and poster presentations by Oct. 6, 2016. Papers should contain original, recent and unpublished results of application research, development or implementation. To submit your abstract, visit www.lia.org/conferences/ilsc/abstract_submission.
“The authors of these submitted papers make up this scientific conference,” states Schulmeister. “The quality of the conference is determined by the quality of the submitted papers as oral presentations, posters and the respective proceedings papers, which are valued sources of information not only for the participants at the conference, but as general references.”
For more information on ILSC 2017, visit www.lia.org /ilsc.
In the words of Sidney Dekker, an expert in learning from adverse events, “the key to an investigation is not to point out where people went wrong, but to understand how their assessments and actions made sense inside that situation at the time.”1
As the laser safety officer, key elements to the investigation phase include:
Visit the location where the event took place
Interview those who were there at the time of the accident
Take pictures; capture the scene
Get a clear explanation of the work being done (consider process mapping)
The new view of safety challenges findings reported in the literature, such as 67 percent of medical laser accidents are attributed to operator error and demands that we look deeper into why these errors were made2. In the words of Trevor Kletz, “listing human error as the cause of an accident is about as helpful as listing gravity as the cause of a fall. It may be true, but it does not lead to constructive action. 3
To truly learn what contributed to the event, the laser safety officer must ensure ‘psychological safety’ of the individuals being interviewed. It is essential that the message be clear that this is a non-punitive process, with the focus of learning and improving, and that messaging is consistent from the manager level to senior leadership.
As in nearly any adverse event, one can point to a procedure or policy that was violated; it is often the first reaction of leadership to suggest that the individual who violated that procedure be held accountable. In deciding whether or not this is appropriate, an important test, known as the ‘substitution test’ is conducted. This involves asking the question whether another individual with the same information under the same circumstances might have made the same decision. If the answer is yes, then it is not appropriate to look at individual performance, but rather to look at the system in which the event took place.
Investigation & Analysis of Incidents The following example is roughly based on Incident no.7, reported to the British Medical Laser Association, and discussed in the paper by Moseley2:
Scenario 1: “Description: Laser used in conjunction with a bronchoscope, LPA was called because a registrar had corneal damage. The procedure had taken about 1 h. Registrar claimed she had worn the glasses. The glasses and equipment were tested and found to be in good order. Follow up and outcome: The scarring resolved and the problem was never solved. No legal action followed. The totally unfounded suspicion of the LPA is that the glasses were abandoned and optimism relied upon instead.”
Concluding that an injury occurred because laser protective eyewear was not worn may be true, but does not lead to constructive action. If one explores why the laser protective eyewear was not warn, a host of reasons could surface;
laser protective eyewear does not fit comfortably
laser protective eyewear color distortion interferes with view of biological tissues
laser operator wears prescription glasses, eyewear does not fit over his/her glasses
laser eyewear for multiple lasers is stored in one drawer, making it is possible to select the incorrect eyewear
the manufacturer (‘expert’) from the company never wears laser protective eyewear when he visits the site
Each of these reasons leads to a different corrective action.
Why-Why Method One method used in patient safety is the “Why-Why method,” where you repetitively ask “why” to arrive at the deeper rooted factors that led to the event. In this example, we might ask:
Q: Why was LPE not worn?
A: “It was not available.”
Q: Why was it not available?”
A: “We don’t know what to order.”
Q: “Why don’t you know what to order?”
A: “The nurse that was our laser safety expert left our team, and no one has replaced her.”
We see by drilling deeper, buying an additional pair of laser protective eyewear would not have resolved the main underlying issue of not having a laser safety specialist supporting the surgical group.
Constellation Mapping A method of analyzing adverse events, known as a ‘constellation mapping’ guides the analysis team to consider how various factors contributed to the outcome:
patient
health care provider (laser operator)
team
organization
environment
equipment
task
This method, introduced in the Canadian Incident Analysis Framework, is a powerful tool in shifting from blaming individuals (“operator error”), to identifying systems fixes that will prevent future adverse events.4 This type of ‘systems’ accident model replaces earlier models that sought out a single ‘root cause.’ The findings can then be organized in to a matrix format i.e., constellation map, as shown in Figure 1.
Figure 1. Constellation map framework [4]
This constellation map is populated with the information gathered during the interview phase. The laser safety officer typically conducts interviews with frontline staff themselves. In interviewing, keeping the questions broad, such as, “tell me what you remember about the event,” often yields the most information. Additional questions can be asked to clarify points, or assess the laser safety culture within the team. If the questions are too scripted, and asked one after the other without giving the individual the chance to first share their story, it can feel like an inquisition rather than non-punitive learning opportunity. It is important to ask the interviewee their ideas for improvements. Often the best suggestions come from the frontlines
It is important to conduct this exercise as a team, to include key perspectives such as a nurse and physician perspective in the health care setting.
The following example is roughly based on Incident no.7, reported to the British Medical Laser Association, and discussed in the paper by Moseley2:
Scenario 2: A laser was fired after a surgical procedure was concluded, when an OR staff cleaning up the OR stepped on the laser pedal, resulting in a skin burn to a fellow nurse who was also in the area.
Rather than quickly concluding that this was operator error (forgetting to put the laser in standby after the procedure), interviews with the surgical team will allow the review team to build a deeper understanding of contributing factors. It is essential in interviews to emphasize that this is a non-punitive process with an emphasis on learning. The shifting of focus to the individual operator to the system, is known as “Systematic Safety Analysis.” A thorough guide for this approach is available online from the Health Quality Council of Alberta.5
In the example of the ‘accidental firing,’ one might find the following through interviews:
The laser pedal does not have a safeguard that would prevent accidentally stepping on ‘fire’ button.
The pedals for the laser and ultrasound are side by side, misfiring of the laser is not uncommon, this is just the first time it lead to injury.
There is no formal laser safety training for surgeons who operate lasers – surgeons visit a site to learn how to use the laser from an experienced surgeon, followed by a period of support from company rep.
Onsite training records show only nurses have attended laser safety training sessions.
The audible indicators that the laser is in the ‘ready’ state are difficult to hear in the noisy or setting.
Organizational pressure to reduce OR time, pre and post procedure LS checklist no longer done.
The surgeon had received an emergency page as the procedure was ending.
Nurse A thought the surgeon had powered down the laser before leaving. The surgeon is used to working with Nurse B who always takes care of powering down the laser at the end of the procedure.
The populated constellation map for Scenario 2 is shown in Figure 2.
Figure 2. Populated constellation map for ‘accidental firing of laser’ scenario
We now have a much richer understanding of the factors that contributed to this event, and many more recommendations to consider than we would if we had concluded ‘operator error’ was responsible.
Recommendations in Response to Incident Continuing with reference to Scenario 2, if we had concluded ‘operator error’ was responsible, we likely would have had one follow up action taking the form of a memo or email to all operators of surgical lasers to ensure the laser is put in standby mode or powered off when not in use.
A method used widely in the patient safety community is the hierarchy of effectiveness of corrective actions as shown in Figure 3.5 Referring to the ‘hierarchy of effectiveness’ of corrective actions, shown in Figure 3, this would be considered ‘inform/educate,’ considered the weakest intervention.
This also reinforces to the entire team that the organization follows up to adverse events with a ‘shame and blame’ approach. It is likely that when the email is sent, everyone knows who exactly forgot to turn off the laser that day.
Figure 3. Hierarchy of effectiveness of corrective actions, established by the Institute of Safer Medication Practices [5]
Through taking a systems approach, and carrying out the exercise of constellation mapping, we have arrived at many more contributing factors that can be addressed through recommendations. In formulating recommendations, it is important to consider this relative hierarchy. Recommendations to consider based on these findings might include:
Equipment: Ensure laser pedals are covered. Consider means of distinguishing ultrasound pedal from laser pedal (geographical separation, visual distinction) to reduce risk of accidental firing.
Standardize the roles in the OR team, including who is responsible for pre- and post- laser check.
Training: Outreach aimed at physician group (rounds, explore whether CME points can be awarded for laser safety training).
For Medical Laser Safety Officers that find it challenging to engage physicians in the laser safety program at their facility, the Institute for Healthcare Improvement white paper “Engaging Physicians in a Shared Quality Agenda” provides strong guidance.6
Sharing Lessons Learned To close the loop, and strengthen the laser safety culture, it is essential to share lessons learned from laser safety incidents. Some methods of sharing include:
Provide a complete report to administration and the LS Committee and regulating body.
Write a Lessons Learned report to share with other laser users (not to blame but rather to point out contributing factors and corrective actions).
Incorporate case studies in laser safety training.
Present the adverse event and lessons learned at a conference.
When other laser users see the ‘systems approach’ taken in response to adverse events, they will be more likely to come forward and report adverse events.
It is important to stress that this methodology can be applied to ‘near misses’ or ‘close calls’ with equally as rich learning. This is, of course, the preferred method of learning, when harm has not occurred. A non-punitive response to adverse events will have a positive effect on the reporting culture, including the reporting of ‘near misses’ or ‘close calls.’
Conclusions It is a worthwhile exercise for Medical Laser Safety Officers to become skilled at applying current methodology used in patient safety to learn from adverse events. Taking a systems approach, and identifying the many contributing factors detailed in Figure 2, leads to constructive change and improvement to the laser safety program.
References
[1] Dekker, Sidney (2006), The Field Guide to Understanding Human Error.
[2] Moseley, Harry, (2004) Operator error is the key factor contributing to medical laser accidents” Lasers in Medical Science 19; 105-111.
[3] Kletz, Trevor A. (1993) Lessons from disaster, How Organizations Have No Memory and Accidents Recur. Gulf Professional. ISBN 978-0884151548, p510.
[4] Canadian Patient Safety Institute (CPSI). (2012) Canadian incident analysis framework, p 44.
[5] Duchscherer C., Davies, J.M. (2012) Systematic Systems Analysis: A Practical Approach to Patient Safety Reviews” Health Quality Council of Alberta (HQCA). Available online at www.hcqa.ca
[6] Reinertsen JL, Gosfield AG, Rupp W, Whittington JW. (2007) Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; (Available on www.IHI.org)
Jodi Ploquin is a Certified Laser Safety Officer (CMLSO) specializing in medical, academic and commercial applications in laser safety with KRMC Inc. Liz Krivonosov is President of KRMC, a firm specializing in the risk management of hazardous materials. She is a Professional Engineer and a Certified Industrial Hygienist.
As LIA’s sales and client representative, I travel to a lot of conferences to connect with our partners and learn about new companies. My latest trip took me to Dallas for the Safety 2015 conference by the American Society of Safety Engineers.
Andrew Morrison
Almost all the interest at our booth regarded our laser safety officer training. Many attendees stopping by to pick up a course catalog asked when and where courses were upcoming. (To stay updated on when and where our courses are being held, check out the training tab on our website.)
It was interesting that people who stopped by were either replacing someone and preparing to become their company’s new LSO, or just trying to get familiar with laser safety since their company had lasers onsite.
I also spoke with a few insurance company representatives who stopped by to gather information for their clients who have questions or need to get trained. A few people were just concerned that their company had no program in place and no training for employees, and they realized the dangers of this.
As our Education Director Gus Anibarro will tell you, it’s not enough to name an LSO for your industrial or medical environment — you need to keep that person trained based on the latest ANSI Z136 laser safety standards, as well as state and federal regulations.
In fact, Gus donated some LSO training for the silent auction at Safety 2015. One visitor to our booth couldn’t stay and chat because she said she needed to run over and get her bid in!
Since LIA is an OSHA alliance partner, we have even trained OSHA compliance officers and consultants on the best laser safety practices.
It’s part of everyone’s job at LIA to point you in the right direction so you can keep yourself and your employees and coworkers safe. We’re always ready to help steer you to the training course that best meets your needs.
That’s why I and my coworkers at LIA are always out there at conferences related to our mission. Think about it: Spending a few thousand dollars on laser safety training can help prevent deaths or serious injuries and save you far more money in accident-related costs in the long run.
Andrew Morrison visits about three to five non-LIA industry events annually to represent LIA and stay in touch with our members. To inquire about exhibiting at an LIA conference or advertising in our newsletter or on our website, contact him at amorrison@lia.org.
ALBUQUERQUE, N.M. — This morning, the International Laser Safety Conference kicks off with the annual meeting of the ASC Z136, the committee that produces the ANSI Z136 laser safety standards. Later, this evening’s welcome reception will be a relaxed introduction to an intensive, informative week.
It’s been two years since the first ILSC I attended, but the impact of that event has remained quite clear. Unlike the rest of LIA’s events, ILSC isn’t all about the wonderful things today’s lasers can help manufacture. ILSC takes a hard look at the damage done when lasers are handled improperly or used under less-than-perfect conditions.
Yes, ILSC does look ahead to new laser technologies and therapies — for example, the future of semiconductor lasers is the subject of a pair of sessions. But the primary focus is the significant human and monetary cost of laser hazards, and the tireless efforts of the experts gathered here to mitigate those hazards.
Among the experts here are dozens of certified laser safety officers (CLSOs) and medical laser safety officers (CMLSOs) who have gone the extra mile to qualify their credentials through the Board of Laser Safety’s tailored programs. Now more than 10 years old, the CLSO and CMLSO programs have bolstered the credibility of laser safety professionals in a broad range of institutions, from NASA and Boeing to numerous universities, laboratories and health-care facilities.
It’s perhaps not exaggeration to suggest that these certified laser safety professionals have prevented millions of dollars in damages and lawsuits thanks to their commitment to pursue CLSO and CMLSO status. One of the many sessions I’m looking forward to will document the changes in attitude of students following laser safety training, research performed by ILSC General Chair John O’Hagan of Public Health England, his PHE colleague Michael Higlett, and John Tyrer, chair of ILSC’s Laser Safety Scientific Sessions.
The biennial ILSC is always an exciting gathering of the top minds in laser safety — the people who write or enforce the standards that keep thousands of workers, researchers and patients safe. The work presented is testament to the discipline of laser safety. To further that discipline, we are asking our CLSOs and CMLSOs to help us create a database of information that attests to the credibility conferred by their certification. Please spend a few minutes taking our CLSO/CMLSO survey; your answers will help us demonstrate the value of certification to your employers and peers.
We look forward to catching up with old friends and meeting new ones this week. Please stop by the LIA booth for exclusive deals on laser safety publications.
Geoff is LIA’s communications director. To share your stories, tips and suggestions, contact him at ggiordano@lia.org.
![Figure 1. Constellation map framework [4]](https://www.laserstoday.com/wp-content/uploads/2016/06/Figure-1.png)
![Figure 3. Hierarchy of effectiveness of corrective actions, established by the Institute of Safer Medication Practices [5]](https://www.laserstoday.com/wp-content/uploads/2016/06/Figure-3-e1465960164334.png)
